| The Therapy Room

THE THERAPY ROOM: Hurricane Irma and the stress and anxiety we experience

Posted on 14 September 2017 by LeslieM

Before making landfall in Florida, Hurricane Irma broke records on its relentless churn through the Caribbean. Irma spent 8.5 days as a major hurricane and sustained 185 mph winds for 37 hours as a Category 5 hurricane — making it the longest cyclone on the globe to maintain such intensity. Irma was the strongest storm that has ever existed in the Atlantic outside the Caribbean and Gulf of Mexico. Irma will break more records and will be with us in many ways, such as through flooding issues, wind damage, power outages, structural damage and destruction to homes, businesses, vegetation, pets, farm animals, vehicles, boats, bridges and roadways.

A high percentage of those living or working in the path of this hurricane, which happened to be the entire state of Florida, experienced stress and anxiety when planning a strategy to deal with the onset and then fall out of this force of nature.

The American Psychological Association states that it is common for people to experience very strong emotional reactions with the arrival of a hurricane and its accompanying damage to homes and community infrastructures. Understanding common responses to extreme events can help you to cope effectively with your feelings, thoughts and behaviors.

Here are steps one can take to help restore emotional well-being and a sense of control in the wake of Hurricane Irma:

Recognize and manage: You have tackled hardships at other times in your life. Tap into the skills you used to get through past challenges.

Network TV and online news: Watching replays of footage from the hurricane can make your stress even greater. Often, the media tries to interest viewers by presenting worst case scenarios and they may not be representative of your home or community.

Ask for and get support: Reach out to people who care about you and who will listen and empathize with your situation. Find out about local support groups led by trained and experienced professionals.

Engage in healthy behaviors to enhance your ability to cope with excessive stress. Eat well-balanced meals and get plenty of rest. If you experience difficulties sleeping, you may be able to find some relief through relaxation techniques. Avoid alcohol and drugs since these can increase a sense of depression and/or impede you from doing what is necessary to be resilient and cope with events.

Individuals with prolonged distress related to Irma that disrupt their daily functioning should consider consulting with a trained and experienced mental health professional to help provide education about best responses to extreme stress and create a plan for moving forward.

As you gather with family, friends and co-workers in the days and months ahead for special events, or to celebrate holidays, reflect on what Hurricane Irma may have taught you and then hold onto those you love a little tighter, and listen with kindness to those you may disagree with in order to find common ground or initiate compromise. The devastation caused by Hurricane Irma helps us acknowledge how precious life is and it can also help us better demonstrate to our self and others an appreciation for this beautiful, amazing and challenging life we have. Change is possible.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information available at www.drjuliabreur.com.

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The Therapy Room: Chronic Pain

Posted on 17 August 2017 by LeslieM

The United States of America is experiencing a national opioid addiction crisis; the use of opioid pain medications has reached epidemic proportions! Those who suffer with chronic pain, defined as any pain lasting more than 12 weeks, and who take opioid medications, are monitored more than ever before by medical professionals who prescribe and dispense them. Monitoring those taking pain medications is important to prevent overdosing and opioid side effects, such as drowsiness, nausea and vomiting. It is important to also look for signs of drug misuse, the development of intolerance and addiction.

Opioid medications include codeine, fentanyl, hydrocodone, hydrocodone/acetaminophen, hydromorphone, meperidine, methadone, morphine, oxycodone, oxycodone/acetaminophen and oxycodone/naloxone. Many medical experts today debate if opioids effectively treat chronic pain and recommend non-opioid pain medications to their patients, such as acetaminophen, ibuprofen, anticonvulsants, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants and topical NSAIDs.

How can someone realize they are becoming dependent or addicted to pain medication? Here are questions to help and, if the answer is “yes” to one or more of these questions, it is recommended one contact a medical professional for further help:

Do you take more pain medication than prescribed?

Do you get pain medications from friends and family versus your pharmacist?

Do you get pain prescriptions from more than one doctor?

In addition to taking pain medication for your chronic pain, do you also take same medication to treat a bad mood, anxiety or to sleep?

Do you spend more time than you should worrying about running out of your pain medication?

Psychotherapy is an excellent collaborative treatment for anyone with chronic pain and/or taking pain medications. As a clinical psychotherapist, I see many patients with chronic pain and after I attain details on the type of chronic pain they experience and medications used I focus on how they respond to their pain. Do they respond to their pain with distressing thoughts that ruminate and magnify pain, along with feelings of helplessness about their chronic pain.  This response to chronic pain is defined as pain catastrophizing and it relates to any depression and anxiety being experienced. Studies show that people who catastrophize have more severe pain, require more pain medication and have reduced response to multidisciplinary pain care. 

Psychotherapy can provide much needed education and relief to a person’s experience with chronic pain.

In addition to psychotherapy, other treatments for chronic pain include chiropractic care, nutritional counseling, weight management, acupuncture, pressure point therapy, salt therapy, biofeedback, meditation, oga, Pilates and various exercise and wellness programs.

A psychotherapy client of mine experiences physical pain from multiple sclerosis and diabetes. If her workday starts in pain, she focuses on making it to lunch time and then maybe treating herself to a frozen yogurt. The simple act of getting through the day by taking small steps and rewarding herself with a treat helps her to manage her chronic pain.

Another psychotherapy client chooses to get off his reclining chair and go for a walk on the beach and breathe in the salt-filled ocean air. He believes that modifying his surroundings and physically moving are solutions to managing his chronic pain and he wants others to know that change is possible.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further Information available at www.drjuliabreur.com.

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The Therapy Room: Hoarding

Posted on 19 July 2017 by LeslieM

By Julia Breur, Ph.D., LMFT

Hoarding disorder is defined by the Diagnostic Statistical Manual of Mental Disorders (DSM-5) as the persistent difficulty discarding or parting with possessions, regardless of their actual value.

Hoarding was considered a form of obsessive-compulsive disorder (OCD) until recently when the American Psychiatric Association recognized hoarding as its own disorder.

This disorder affects both males and females, but epidemiological studies report a significantly greater prevalence among males. This contrasts with clinical samples, which are predominantly female. Hoarding symptoms appear to be almost three times more prevalent in older adults, ages 55-94 years compared with younger adults ages 34-44 years.

Difficulty and distress comes into a hoarding individual’s world when there is a need to discard possessions or the accumulation of possessions that congest and clutter living areas and compromise their intended use. These individuals may not see their hoarding behavior and their collected items as a problem, making any treatment challenging. Hoarding is also known to cause depression, anxiety, anger and resentment among a hoarding individual’s family members.

Compulsive buying, the compulsive acquisition of free items and even the compulsive search for perfect or unique items is part of hoarding. Individuals with this disorder believe that an item will be useful or valuable in the future, has sentimental value, is unique and irreplaceable, or is too big a bargain to throw away. They may also consider an item a reminder that will jog their memory, thinking that without it they won’t remember an important person or event. Sometimes they can’t decide where something belongs and think it’s better just to keep it. Hoarded items usually include paper products, such as newspapers, magazines, boxes and photographs, along with grocery items, food and clothing. Some individuals also hoard animals.

Hoarding is very different than collecting. In general, collectors have a sense of pride about their possessions and they experience joy in displaying and talking about them. They usually keep their collection organized, feel satisfaction when adding to it, and budget their time and money. Those who hoard usually experience embarrassment about their possessions and feel uncomfortable when others see them. They have clutter, often at the expense of livable space, feel sad or ashamed after acquiring additional items, and they are often in debt.

Many individuals live with broken appliances and without proper air ventilation and other living conditions of comfort. They cope with malfunctioning systems rather than allow a qualified person into their home to fix a problem. Unlivable conditions that are a result of hoarding are known to lead to divorce, eviction, loss of child custody and serious financial issues.

To assist in the recovery of a person who hoards, engage with care and compassion. Point out the risks and safety concerns, such as fire hazards, and slipping and falling potentials, versus accenting blame and shame. Develop a small step by small step strategy and, as key milestones are achieved, encourage and point out accomplishments being made. Many hoarding individuals have organizational challenges and you can help by enhancing concrete skills such as use of a calendar, time management and setting goals. Hoarding information, resources and support for families, friends, spouses and the hoarding individual can be found at childrenofhoarders.org

A&E’s television show, Hoarders and TLC’s television series Hoarding: Buried Alive have brought this disorder into greater public awareness and discussion. Physicians, researchers and psychotherapists continue to develop new and effective hoarding treatment plans and, with an active and flexible support system in place, change is possible.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton, FL. For more information, visit www.drjuliabreur.com.

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The Therapy Room: Risks and rewards of online gaming

Posted on 15 June 2017 by LeslieM

Are you a “Gamer?” Someone who consistently spends time playing online video games on a personal computer (PC), console or a mobile device, such as a smartphone or tablet at least three to four times a week. Today, there are 2.2 billion gamers worldwide generating over $108.9 billion in revenue.

Playing online games over the Internet has become second nature. Millions of users enjoy playing with their family, friends and strangers competitively, and just for fun. The current on-board hardware of gaming consoles, PCs and other mobile devices can only offer certain levels of performance. The capabilities of cloud computing has the attention of gaming developers and gaming will see non-time sensitive processes, such as artificial intelligence taken on by cloud servers.

Many of my Psychotherapy patients, ranging in ages from 10 to 90 years, are gamers. Those with Autism Spectrum Disorder (ASD) experience positive interaction with peers and develop social skills playing a game called Minecraft. A CEO plays online games that involve strategy and skill while traveling on business. A freelance writer has joyfully confessed that she was a Pac-Man fanatic in the 1980s and continues playing Pac-Man online today. She told me she learned a life lesson playing Pac-Man, that you don’t always have to keep going or playing fast to meet goals, you can actually achieve great thing by stopping or being still. An accountant believes that if the time and energy put into gaming were applied to something worthwhile, positive results would be endless. There are numerous opinions, as well as risks and rewards, when it comes to online gaming. Let’s highlight a few:

Rewards:

Gaming allows you to interact online with other people and be social.

No need to disclose your identity (unless you want to); you can use a fictitious name.

Gamers have fun and experience good feelings about self and others while playing various online games.

Risks:

Absenteeism from work, school and other commitments can be high due to competing in and playing online games.

Relationships may suffer due to a partner’s invested time playing online games and interactions that develop with other gamers.

All ages play online games; a child might represent them self as an adult and an adult may present as a child.

There are dangerous “games” (For example, those introducing swallowing cinnamon, huffing and more).

Parents be aware of a game’s child safety measures and guidelines. Understand what single player and realms are and monitor your child’s online playtime.

Online gaming is here to stay! Rather than dismiss it, be curious and ask your children, and others, about their online gaming knowledge and experiences. Gaining new insight to others’ interests allows you to realize that within you … change is possible.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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THE THERAPY ROOM: ADHD or Attention-Deficit/Hyperactivity Disorder

Posted on 18 May 2017 by LeslieM

Have you noticed the new fidget widget toys being sold at retail and online stores? When played with, these toys help alleviate stressful behavior. Fidget widgets are popular with ADHD children and adults, but what exactly is ADHD?

Attention-Deficit/Hyperactivity Disorder is one of the most common neurobehavioral disorders of childhood and it has had numerous names, including “learning behavior disability” and “hyperactivity.” In 1987, the disorder’s name was refined to Attention-Deficit/Hyperactivity Disorder, or ADHD, and only recently have clinicians acknowledged that the symptoms of ADHD may continue into adulthood.

The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Inattention manifests behaviorally as wandering off tasks, lacking persistence, having difficulty maintaining focus and being disorganized but not due to defiance or lack of comprehension. Hyperactivity is excessive motor activity, excessive fidgeting, tapping or talkativeness. Impulsivity are hasty actions that occur in the moment without prior thought and have potential for harm to the individual, looking for immediate rewards, inability to delay gratification, social intrusiveness and even making fast decisions without considering potential consequences.

ADHD affects boys more than girls. The condition tends to run in families and no one knows how many adults continue to be affected by the remnants of this disorder. Alcoholism, divorce and other family disruptions are common markers associated with ADHD.

There is no single test to diagnose ADHD. Healthcare providers diagnose ADHD with the help of the standard guidelines from the American Academy of Pediatrics or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Also, a medical exam is usually recommended to include vision and hearing screenings.

Here are some tips for parents with a child diagnosed with ADHD:

Remain calm: a child’s anger will only escalate if a parent becomes angry. Diffuse, do not engage!

Help your child make good choices: During homework time, ask your child, “Do you want to do history or math first?” Driving in car ask, “What type of music should we listen to?” or “Should we turn the music off and talk about your school day?”

Do not take behavioral setbacks personally: All children make mistakes and it can be an opportunity for a parent to teach better choices, for example, saying, “We can do this better together.”

Be persistent: Never give up trying to help and teach your child; it may feel like you have explained better choices of behavior 50 times, but that 51st time might lead to signs of positive progress.

Focus on your child’s strengths and take notice of their interests: Your ADHD child may be our future U.S. president or a medical doctor, author, engineer, athlete, teacher, etc. Encourage and involve your child in what interests them. You may also learn a new thing or two along the way and always remember … change is possible!

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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